ReAct Booking Form

Respect in Action (ReAct) Booking Form

Thank you for your interest in ReAct. Please submit this form at least 24 business days before the requested date. If you would like to request more than one workshop, training, and/or speaking engagement, please submit a new form for each request.

General Information
*Contact name:		*Contact title:
*Full organization/school name:		*Organization/school mailing address:
Email address:		Website:
*Phone number:		Fax number:
Invoice:	Yes, please send me an invoice	METRAC email list:	Yes, please add me to METRAC's email list

Booking Information
*I am requesting a ReAct (pick one): Mini workshop for youth (1–1.5 hours) Full workshop for youth (3 hours) Train-the-Trainer workshop for educators and/or youth workers (you will be contacted about scope and length) Speaker for a panel, assembly, event, or conference (you will be contacted about scope and length)
Is this workshop/training/speaking engagement being requested as a result of specific incidents of violence or abuse participants have experienced in the past 6 months? No Yes Note: If yes, we will follow up for more information*
*Please indicate requested workshop/training/speaking date and time options:
What topic is being requested (choose one topic per requested workshop/training/speaking engagement)? Ending the Silence: Violence at Home What’s Love Got to do With It?* Dating Violence What’s Love Got to do with it? Dating Violence for LGBTQ Youth Only Yes Means Yes! Sexual Assault/Date Rape Our Power, Our Privilege: Intro 2 Anti-Oppression Tough Guise: Masculinity Feeding or Starving the Hype: Youth At-Risk and Violence Going Beyond the Massacre: December 6th Remembrance Why the Looks? Bullying Between Young Women Speak Your Truth: Empowerment for Young Women Speak Your Truth: Empowerment for Young Mothers Love or Obsession? Stalking The Bully Factor Gender-Based Violence
Additional comments about this request (please specify if you require an invoice and details of what should be on it):
What would you like to accomplish through this workshop/training/speak?

Information About Participants

What number of participants is expected to be present?

Minimum #:
Maximum #:

Participant age range?

0–15 years
16–24 years
25–64 years
65+ years

What grades are they in (if applicable)?

Genders?

# of females:
# of males:
# of Trans-identified:

How many are Newcomers (Immigrants and Refugees) and/or ESL learners?

Newcomers:
ESL learners:

How many are Deaf or hard of hearing?

If there are Deaf or Hard of Hearing participants in the group, are ASL interpreters available or present?

Yes
No
N/A

How many have known disabilities?

Learning disabilities:
Vision disabilities:
Physical disabilities

How many are of colour (e.g. African, Caribbean, East Asian, South Asian, Arab, or Latin American descent)?

How many identify as Lesbian, Gay, Bisexual, Queer, or Questioning?

Note: fees allow us to do violence prevention work with youth. Our fee scale is:

Mini-workshop (1-1.5 hours): $75
Full workshops (3 hours): $150

Please contact us concerning fees for trainings and speaking engagements.

Please make cheques payable to METRAC (158 Spadina Road, Toronto, ON, Canada, M5R 2T8). Invoices can be provided, if requested. ReAct offers workshops, trainings, and speaking engagements outside of Toronto; however, additional fees will apply to help cover costs. Contact us for details.